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Challenges in Endodontics

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Two distinctions should be recognized1.This is the only dental treatment that

depends heavily on the tactilesensation of the fingers of theoperator.

2.The inability of the clinician tovisualize three dimensionally theanatomy of the pulp.

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Curved canals offer a wide range of anatomicalshapes that can lead to procedural errors such as,

ledge formationZipping

strip perforationapical perforationtransportation

during cleaning and shaping

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Not extending the access cavity sufficientlyIncorrect assessment of the root canal directionErroneous root canal length determinationComplete loss of control of the instrumentForcing and driving the instrument into the canalUsing noncurved S/S instrumentFailing to use the instrument in sequential order

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Instrumentation techniqueRoot canal curvatureType of toothCanal locationRe-treatmentUndergraduate work

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ClinicalStraightened the curve canalNo sensation of curveDead end feelingTip binding is lossNo tactile sensation of tensional

binding

RadiologicalInstrument point away from the lumenFile deviated from the natural pathway

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Careful and attentive instrumentationLearn from own mistake and others mistakeAppropriate preoperative and post operative X-RayCopious irrigationPre-curved filesIncremental instrumentationCareful attempting to remove blockage

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Williams - 1951 Heling and Karmon - 1976

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Knowledge of root canal anatomyTypical variations from normal.Knowledge of variations that will not be visible onradiographsProbing floor of pulp chamber with endodonticexplorerDigital perception with hand instrument in canal.

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Pulp chamber anatomy and relationship to occlusalanatomy

Estimated root canal lengths

Root curvature (morphology)

Root canal diameter ( preparation technique required)and Stage of root development (open apex, etc)

Canal obstructions, calcifications

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1.Remove all the carious dentineand bad restorations

2.Remove gum polyp3.Place matrix band and holder4.Restore with GIC5.Place rubber dam / isolate with cotton role

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Remove the entire roof of the pulpchamber

Provide direct-line access to the apicalthird of the root canals.

Avoid damage to floor of the pulpchamber.

Enable a temporary seal to be placed.

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Average tooth length

Radiographic length

First bound length

Pain length

Apex locator length

Calculate Provisional working length

Operative radiograph

+/- 2mm to apex;

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Dissolve organic debrisFlush out inorganic and organic debrisLubricate endodontic instrumentsEliminate micro-organismsBleaching of tooth to prevent staining

0.05-5% Sodium Hypochlorite

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Easier to insertion of fileReduced the stress to the fileAssist to remove debrisSoften the dentinRemove the smear layer

EDTA, Silicone, glycerin and wax lubricant paste

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ANTI CURVATURE FILING CIRCULAR FILING

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Zipping

When a curved foramen is filedwith a small file with pressureagainst the outer side of thecurvature, repeated filing Zips andtransport the foramen.The curved area of the foramen isnot cleaned and retains tissuedebris. Foramen cannot beobturated totally and failure of theRCT is certain.

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Strip perforation

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File separation

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In the straight portion of the canal, Loosen itwith a H file or an ultrasonic instrument and pullthe part out with a H file or with a curvedmosquito forcep or a locked tweezer.It may evenbe flushed out if loosened sufficiently.

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.Special instrumentsAre available to disengage hold andremove separated instruments from rootcanals.Eg. Cancellier instrumentsTrepanbur,Messerann extractorsIRS Instrument remover (Dentsply) etc.

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